Enery Gómez-Montes

Characterization of the soluble fms-like tyrosine kinase-1 to placental growth factor ratio in pregnancies complicated by fetal growth restriction.

OBJECTIVE: To characterize the values of the soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) ratio in pregnancies with fetal growth restriction with or without concurrent preeclampsia or hemolysis, elevated liver enzymes and low platelets syndrome (HELLP) and in pregnancies with normally grown fetuses with or without concurrent preeclampsia or HELLP. METHODS: This is a case–control study performed in two centers (Berlin and Madrid) consisting of 171 singleton pregnancies complicated by fetal growth restriction (n=27), preeclampsia or HELLP (n=105) or preeclampsia or HELLP and fetal growth restriction (n=39) pairwise matched by gestational age with 171 healthy control pregnancies. Automated measurement of sFlt-1 and PlGF in maternal serum samples was performed after diagnosis (cases) and in gestational-age matched healthy control samples. Samples were analyzed for two timeframes: before and at or after 34 weeks of gestation. RESULTS: Pregnancies with fetal growth restriction, preeclampsia or HELLP, and preeclampsia or HELLP and fetal growth restriction showed higher median values of sFlt-1/PlGF ratio than control pregnancies both before 34 weeks of gestation (90, 231, 514, and 3, respectively, P<.001) and at or after 34 weeks of gestation (117, 66, 165, and 11, respectively, P<.001). The differences among the case subgroups were not statistically different. CONCLUSION: Fetal growth restriction is characterized by elevated maternal sFlt-1/PlGF ratio, reaching values as high as those observed in preeclampsia or HELLP. LEVEL OF EVIDENCE: II

Uterine artery Doppler and sFlt‐1/PlGF ratio: usefulness in diagnosis of pre‐eclampsia

To evaluate the usefulness of the mean pulsatility index of the uterine arteries (mPI‐UtA) and automated measurement of the soluble fms‐like tyrosine kinase 1 (sFlt‐1)/placental growth factor (PlGF) ratio on suspicion or at diagnosis of pre‐eclampsia (PE).

Prediction of coarctation of the aorta in the second half of pregnancy

To determine which combination of cardiac parameters provides the best prediction of postnatal coarctation of the aorta (CoAo) in fetuses with cardiac asymmetry.

Gestational age-specific scoring systems for the prediction of coarctation of the aorta

To determine which combination of cardiac parameters provides the best prenatal prediction of coarctation of aorta (CoAo).

Pulmonary atresia/critical stenosis with intact ventricular septum: prediction of outcome in the second trimester of pregnancy

To determine which cardiac parameters provide the best prediction of postnatal outcome—biventricular (BV) versus non‐BV—in fetuses with pulmonary atresia/critical stenosis with intact ventricular septum (PA/CS‐IVS).

Prenatal diagnosis of neonatal Marfan syndrome

Cristina Gavilán1, Ignacio Herraiz1, Miguel A. Granados2, Marı́a T. Moral3, Enery Gómez-Montes1 and Alberto Galindo1* 1Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, Hospital Universitario “12 de Octubre”, Universidad Complutense de Madrid, Madrid, Spain 2Pediatric Heart Institute, Department of Pediatrics, Hospital Universitario “12 de Octubre”, Madrid, Spain 3Neonatology Unit-SAMID, Department of Pediatrics, Hospital Universitario “12 de Octubre”, Madrid, Spain

Longitudinal changing values of the sFlt-1/PlGF ratio in singleton pregnancies with early-onset fetal growth restriction

To describe the evolution of soluble fms‐like tyrosine kinase‐1 to placental growth factor (sFlt‐1/PlGF) ratio in the last 5 weeks prior to delivery in singleton pregnancy complicated by early‐onset fetal growth restriction (FGR), with or without pre‐eclampsia (PE).

Impact of prenatal diagnosis of transposition of the great arteries on postnatal outcome

Abstract Objective: To assess the impact of prenatal diagnosis of transposition of the great arteries (TGA) on postnatal outcome. Methods: Hundred and fifty-four patients with either simple (n = 101) or complex forms (n = 53) of TGA, diagnosed prenatally (G1, n = 88) or postnatally (G2, n = 66), who were admitted and underwent surgical correction in our centre between 1998 and 2014, were analysed. Results: Prostaglandin E1 (PgE1) infusion and balloon atrial septostomy (BAS) were performed in the first 48 h after birth more commonly in G1. The hospital mortality rate for the whole group was 7.1%, higher for complex forms (13.2%) than for simple TGA (3.9%), (p = 0.034). The overall mortality rate was similar in G1 and G2. The mortality for simple TGA was higher when PgE1 infusion and BAS were implemented after the first 48 h (p = 0.001). All deaths in G2 occurred in patients first receiving PgE1 and BAS beyond 48 h. PgE1 was initiated in the first 48 h in most patients (83%) with simple TGA postnatally diagnosed. Conclusions: Adequate measures in the first 48 h after birth are essential to reduce the early mortality in TGA, especially in the simple form. This can be provided by prenatal diagnosis or by early neonatal clinical suspicion and prompt measures.

Fetal Aortic Valvuloplasty: Experience and Results of Two Tertiary Centers in Spain

Objective: Fetal aortic valvuloplasty (FAV) may avoid progression of critical aortic stenosis (CAS) to hypoplastic left ventricle, improving the options for biventricular circulation (BVC). We describe the results of FAV in 2 referral centers in Spain. Methods: We analyzed all FAVs performed in the period 2007-2015. The selection of candidates, the technique, and postnatal management were made following an agreed protocol. A descriptive analysis of survival, type of circulation after birth, and complications was made, considering all deaths in the first 48 h after FAV as FAV-related. Results: FAV was performed in 28 fetuses at a median gestational age (GA) of 23 weeks (range, 20-32). FAV was technically successful in 22 (78.6%), of whom 11 were born alive and with intention to treat. Eight (72.7%) resulted in BVC and 3 (27.3%) in univentricular circulation. The rate of FAV-related deaths was 32%. These patients underwent FAV earlier than live-born fetuses (median GA at FAV 22 weeks [range, 20.0-25.0] vs. 24.5 weeks [range, 21.0-32.0], respectively, p = 0.031). Conclusions: A significant proportion of fetuses with CAS who undergo technically successful FAV have BVC postnatally. However, FAV implies a high risk of fetal death, which highly depends on the GA at which this intervention is required.

Prenatal Prediction of Surgical Approach for Coarctation of the Aorta Repair

Objective: To evaluate the capacity of fetal echocardiography for predicting the more likely surgical approach in newborns with coarctation of the aorta (CoAo) (left thoracotomy vs. median sternotomy). Material and Methods: We selected all cases of suspected CoAo prenatally diagnosed in 2003-2012 (n = 95). 49/95 were considered at high-risk and 46/95 at low-risk of CoAo, and 38/49 and 7/46 were postnatally confirmed, respectively. We firstly evaluated in 40 cases of CoAo surgically repaired (24 thoracotomy, 16 sternotomy) whether there were differences in fetal echocardiographic parameters between both groups. Secondly, we assessed the performance of these parameters for predicting the surgical approach in fetuses at high risk of CoAo. Results: Sternotomy approach was associated with higher rate of postoperative complications and longer hospital stay compared with thoracotomy (81.3 vs. 41.7%, p = 0.014; 30.5 vs. 15.4 days, p = 0.0004, respectively). The Z-score of the aortic isthmus, measured in the sagittal plane, was significantly smaller in the sternotomy group. In fetuses at high-risk of having CoAo a cut-off value of the isthmus Z-score ≤ -2.5 had sensitivity of 78% and specificity of 82% for predicting sternotomy approach, with 9% false positive cases in which CoAo was not confirmed. Discussion: The surgical approach for CoAo repair may be prenatally predicted by means of the Z-score of aortic isthmus, measured in the sagittal plane.